Thank you to everyone who joined us for the premiere of our conversation with rural journalists, an event co-hosted by the Rural Assembly and Daily Yonder. The recording and transcript are available below and can also be found at the Daily Yonder Youtube page.
TIM MAREMA: Hello, and welcome to this conversation about rural America and the COVID-19 pandemic. I’m Tim Marema, editor of The Daily Yonder, and this event is sponsored by The Daily Yonder and the National Rural Assembly. First of all, all of us at the Daily Yonder and the National Rural assembly and our parent organization, the Center for Rural Strategies, we all hope that you and your loved ones are safe and well during what are challenging times. Today, we’re going to be talking with three journalists who cover a big swath of the people and places related to rural America. And we’re taking an approach like this because we know the United States small towns and rural areas are big, diverse and complicated. There’s a lot of stories out there, not just one, so we hope to cover some ground in that direction.
The Coronavirus infection rate in rural America is less than half of the rate in urban areas. But there are parts of rural America that have been hit at least as hard as the worst urban areas. These include ski resorts and recreation counties, parts of the Deep South, tribal lands, counties with prisons and meatpacking facilities are some of the examples. 90% of the rural counties in the US, about 2000 counties in all, 90% of those have at least one case of COVID-19. So it is spread more or less nationally.
So I want to talk about the Coronavirus pandemic and its effects on small towns in rural areas and I have three accomplished journalists to help us tell that story. Chris Clayton is Ag Policy editor at DTN Progressive Farmer. April Simpson covers rural issues for State Line, a national news project of the Pew Charitable Trust. And Jourdan Bennett-Begaye is the Washington editor of Indian Country Today, which covers Native American news nationally. So thank you all for being here, really glad you’re here.
Let’s start by roughing out where some of the hotspots are in rural America for COVID-19. I want to start with Chris, who’s in western Iowa. And what can you tell us about from where you’re sitting and what you’ve read and what you’ve witnessed, what types of rural areas seem to be having a tougher time with COVID-19?
CHRIS CLAYTON: Well, thanks for having me on this, Tim. Really, much of the greater Midwest area, it really has been the packing plant cities and towns. We have quite a few packing plants. The stretch, really you’re looking from Indiana on to Colorado. Anywhere you have one of those larger facilities right now, you have seen a lot of cases. There are a lot of towns with larger packing plants where you have a couple hundred cases but they’re not really getting the reporting attention that maybe you’ve seen from Sioux Falls, South Dakota or a few other hotspots.
That has really been the areas that have been hit pretty hard. It’s caused a lot of challenges for livestock producers but you have hundreds of people working at these plants who have become sick. Now nationally, I think the Food and Environment reporting network I think [inaudible 00:08:42], it’s at least 25 cases, fatalities now of people who work at the packing plants who have died from COVID-19.
TIM: Thanks, Chris. And April, I want to ask you, if you can help fill in any other ideas about where difficulties are occurring with COVID-19 and rural America. I know you’ve done a lot of work in the south though you report nationally. Is there anything that you see that kind of helps paint a picture of what types of communities in rural America are being affected the most?
APRIL SIMPSON: Well, yeah, you hit on it. The South is definitely a place that’s been disproportionately affected. And a lot of that has to do with, or at least part of that has to do with there being a number of states that haven’t expanded Medicaid. Also, just a lot of rural hospital closures and this pandemic is putting a lot more pressure on those hospitals as well. In terms of Medicaid expansion, those hospitals are very reliant on, rural hospitals are very reliant on Medicaid and they’re just not able to be compensated fully for the care that they provide.
On top of that, you have places that are, or demographics, you have African Americans in the south who have worse health outcomes, especially those who live in poverty. There are a lot of folks who have diabetes, hypertension, heart disease, and so on, comorbidities that make this virus more difficult to manage. So, I think the South is another place that we should take a closer look at.
TIM: Thank you, April. And Jourdan, we know that tribal lands are also part of this picture of what’s happening in rural America with COVID-19. What are the numbers that you’re seeing out in Indian Country?
JOURDAN BENNETT-BEGAYE: Thanks for having me on again too [inaudible 00:11:01]. It is definitely affecting the Navajo Nation, which has been the highlight of mainstream media right now. They have well over 1000 cases, more than that right now, as well as the record number of deaths they have. I think it’s around 73 as of this weekend. But Navajo Nation is part of three states, Utah, Arizona, New Mexico, and they are in a rural area of the Southwest. Indian country spans much more than that.
Up north, you have the Mandan, Hidatsa and Arikara Nation in North Dakota that’s being affected by it. Cherokee Nation and Choctaw have a number of cases as well. Cherokee actually recorded I think about two deaths right now. Choctaw has two, I can recall. A lot of California tribes are also in rural areas. There’s issues with trying to access testing. If testing is available out there, I guess, their health clinics nearby or hospitals. And there’s also the issue with trying to figure out how to get paid for as well for those living in rural areas and urban Indians as well. And then there’s also the lack of data collection, that’s an issue in Indian country. But the way it’s hitting Indian country now is just highlighting how, of course, chronically underfunded Indian health service is, but also, tribal governments, and just the federal government [inaudible 00:12:36] treaty rights because tribal governments, tribal nations are supposed to have access to health care. This is just really exacerbating that issue right now.
TIM: Thanks, Jourdan. I want to follow up on kind of a related point with that. And April, I’ll toss this one out to you. The idea that there are these historical issues, these historical problems or conditions that have been there in rural America and other communities for a long period of time, sometimes generations. And COVID-19 is sort of shining a backlight on those and highlighting what are ongoing issues. Do you kind of agree with that sentiment? Is that part of what we’re seeing of COVID-19 is just a continuation or exacerbation of the issues that already existed?
APRIL: Absolutely. I think especially now, the most interesting stories are about those folks who are on extreme margins and where we can look at the disparate intersections among different disparities. So, for example, I did a story recently about black maternal health care. That was a story that focused on black women who are disproportionately two to three times more likely to die during childbirth than white women. The South again has its own challenges regarding rural health care. Over the course of my reporting learned that more women are looking at home birth as an option and assisted home birth as an option because of their desperation to avoid hospitals right now.
And in terms of, as you pointed out, long standing issues, there are very few black midwives in the south. And part of that is because of a push to have more births in hospitals, but also targeted efforts to reduce the number of black midwives in several southern states. So, absolutely, there have been disparities that are just being projected right now by this pandemic.
TIM: Chris, does any of that play out for meatpacking communities or other parts in the Midwest that have had high infection rates? Are there underlying conditions that have been there for a while that are part of why that’s happening you think?
CHRIS: Well, April touched on one of the big issues early on. It’s just simply the the closing of hospitals that we’ve had in rural America. And the states that have not increased Medicaid coverage are the ones that have been hardest hit. Even leading up to the pandemic, we were getting some studies in early February, highlighting the number of rural hospitals have closed over the last 10 years. And we were all going, wow, that’s really terrible. And then you could see the pandemic coming down the line that it was going to exacerbate everything.
Some of the problems that you have in packing plants is, one of the biggest issues really is a language problem. It’s not simply one or two languages being spoken, it’s not just simply English or Spanish. When the Sioux Falls, South Dakota plant Smithfield owns, talking about 3500 workers there. Well, the Centers for Disease Control noted there are over 40 languages spoken at that plant, which is astounding. You have a lot of refugees, packing plants have hired a lot of people in the country over the last several years with refugee status. So, you have a lot of languages that are being spoken.
I was at a health care clinic on Saturday and a doctor who was treating me for minor stupid mistake I had, she actually lives in a meatpacking town in Nebraska, where she was saying, there are over 30 languages being spoken there and a lot of people who work at the plant didn’t actually understand what was going on with the healthcare crisis with the COVID-19 with the pandemic. They weren’t getting news, they weren’t getting any information from coworkers or their employer because they don’t speak the language that information was being put out there. So they were even more vulnerable perhaps to contracting the virus because nobody was telling them exactly what was going on. And that went on for weeks apparently.
TIM: So, Jourdan, what are some of the issues in Indian country that have contributed to the higher infection rates, especially out in the four corners area, which I think is the part of the country with Native Americans that we’ve seen more reporting on probably than other parts of the US?
JOURDAN: And I think Chris definitely hit on one of the points. I think a lot of backs up what people have been speaking anecdotally about that the lack of indoor plumbing has been one. Non-English languages speaking in households. Just the household crowding. Those have been spoken about anecdotally, and just recently four indigenous researchers found with our data and with the American Community Survey that this holds to be true. That’s a big breakthrough because a lot of the times, these are just spoken about from experience and there’s really no data for it. But they found that there is.
And within that study too, they also found that the rate of COVID-19 cases per 1000 people on a reservation is more than four times higher than the US as a whole. I think that just speaks true to, that these three biggest drivers of the community spreads, lack of indoor plumbing, crowded households and non-language, or non English languages and different communities are a part of those reasons.
But a lot of Indian country, it is very community-oriented. Growing up, when we go to our relative’s house or the people’s houses, we’re taught to shake everybody’s hand, say hello, acknowledge them. When you leave, you have to do the same thing. I know my parents would be like, go hug your aunties, go hug your uncles, go say bye. Even [inaudible 00:19:55], it’s still a matter of respect. As a sports writer for The New York Times wrote, the New York Times, she said, now this custom’s coming at a cost, and I believe that’s so true at this point. In Navajo Nation, they suspect that there was this religious gathering that was happening in [inaudible 00:20:16] Arizona. And there is religious gathering, other gatherings that day, and they believe that that’s where this epidemic started, where people hugging each other, shaking hands, and everybody goes off to their different communities wherever they are out there.
And it’s just something, what she said, it’s a custom that came with a cost and it’s probably one of the drivers of what’s going on right now, as well just the lack of healthcare too. You have a lot of people who go to these gatherings in one car because they can only afford a car. They go back to wherever they go, taking care of their elders, and elders is a huge, we respect our elders in native communities, and they’re the ones who are most susceptible. So there’s also that conflict there where you’re supposed to spread the love to them by staying away from them and not being close to them. And so that’s really hard to overcome and allow, and as well as a lot of tribal leaders within the communities too.
TIM: Oh, that’s fascinating. And as you’re talking, I’m thinking of services I’ve attended, where if you didn’t shake hands all around, you were being very rude. It was expected. And there’s one particular denomination in Eastern Kentucky near where I’m from where literally you go around and shake hands with everyone in the sanctuary.
CHRIS: We would do that every Sunday basically. Jourdan touches upon this issue that we’re going to have this problem again next weekend, Mother’s Day weekend. We had it over Easter weekend, and I was writing pieces before Easter trying to tell farmers, you have to ignore all of your cultural norms that you’ve been used to for Easter weekend this time. Now we’re going to have Mother’s Day weekend coming up, with all the restaurants now having opened up, being told you got to stay at 50%. I’ve never taken my mother out on Mother’s Day where you didn’t have to wait two hours to get into a restaurant.
CHRIS: So, I’m concerned about what’s going to happen after Mother’s Day because I get the feeling that everybody will throw the risk out the window because they want to take mom to go eat some pancakes somewhere whatever. I think this is going to be a challenge around the country and rural areas everywhere. Everybody’s going to want to go out and go to a restaurant and it’s going to overwhelm the ability for the people who work there to say I can only see so many of you guys at a given time. [inaudible 00:23:01]
TIM: Part of my Sunday morning, I went to church by Zoom, and then I went for a motorcycle ride past many country churches. And some were open, some were not, I’m in East Tennessee. The ones that were open tended to have the doors open and there was some parts of the congregation were out in the parking lot, which I thought was an interesting adaptation. So they could accommodate more and I think the ones that were a little more at risk probably were out there where they could get a little more space.
Let’s talk a little bit about efforts that have been coming from the federal government to address some of the issues the economic issues, especially in the nation. So April, there’s been two major relief packages passed. Have you seen a difference in how these packages have been rolled out into rural areas? I’m not sure if we talked about this issue or not, but about the ability of the current systems to get money out to assist rural communities the way they need it.
APRIL: So I’m taking a closer look at first CARES Act right now. In that bill, there’s $150 billion to states, and then there’s also targeted funding that goes or is included in that that goes to localities with a population greater than 500,000. But some would argue there’s a report that was out from the Center for American Progress last week. They’re arguing that basically because there isn’t targeted funding for rural areas, rural places are going to be left out. We don’t know exactly what this is going to look like yet because it’s just making its.
APRIL: I was talking to someone from Tax Foundation today, and he was saying states haven’t really put out any guidelines yet saying how they’re going to make sure that this distribution is equitable, so we just kind of have to wait and see. But there is funding in that bill as well for areas like telemedicine and broadband. Granted it’s in the millions and not in the billions. I was talking to somebody else today from, I think it’s the Center of Rural Innovation, Cory, he was saying that this is helpful funding and it does provide some short term help. But yes, we do need funding in greater sums to get rural America online in a way that’s equitable with urban areas.
TIM: Jourdan, I know that’s a big issue for Indian country in how those packages were put together and how the funding does or does not move into the tribal nations. Can you tell me more about what’s happening there?
JOURDAN: Yeah, sure. It was the third relief package, tribes got $8 billion. This would go to tribal governments so they can deal with the pandemic. But there’s also an additional two million for federal Indian programs, such as the Indian Health Service, the Bureau of Indian education and the Bureau of Indian Affairs, and a few others. However, there’s been like a lot of, there’s been conflict about how soon to get this funding to tribes. They’re supposed to, the Treasury Department was trying to get out to tribes by April 26. I’m not sure if that has been done yet because there’s been also lawsuits by some tribes suing the Treasury Department saying that Alaska Native Corporation shouldn’t be part of this disbursement. And part of that was because, one, we don’t know how the Treasury Department is going to disperse this money to tribes. Then what it looks like. Right now, they’re thinking that the formula would be using land base, which Alaska Native corporations own about approximately like 40 to 44 million acres of land in Alaska. And so, they would get a majority of the funding, and tribes in the lower 48 states wouldn’t get a lot of that money that’s needed. Overall, like $8 billion wasn’t a lot of money. There was no more money that was needed to cover a lot of the costs in Indian country.
So for right now, last Monday, April 27th, the federal judge ordered the Treasury Department to help the distribution to Alaska Native corporations, but they could still send checks to tribes. We haven’t heard anything yet about if that’s been done yet however.
TIM: Which underscores the complexity of everything done with tribal nations and the relationship between federal government and the tribes. I recall in the first package, I believe there was money allocated to the Centers for Disease Control for tribal work, and they had no program through which to distribute it. So, there are things that happened like that just because the systems are all different and complicated.
JOURDAN: Yeah, exactly. That’s also just to see how the Indian Health System overall is structured, but Indian Health Service is only a small part of the Indian Health System, they’re about 17% of that. And the other like 83%, they are run by health clinics, are owned and operated by the tribes. They also think about Medicaid as well as VA hospitals and Purchase Care which is where a tribal citizen can go to IHS. And if they need to see a specialist outside IHS, they can get referred out, but that cost is still covered by IHS itself. It’s just like complex too in how tribes are structured. It does lead talk about all the complexity of Indian country where native people aren’t a monolithic group. We are sovereign nations and our tribal governments are structured differently as well.
TIM: Thank you. Well, I want to move toward closing up with the idea that less is often more. There’s a lot more we could talk about here and I look forward to reading and hearing more about each cover, looking to what comes next in this big story. Chris, let me start with you kind of going around the horn about what what you’re working on, what you see as the future of the pandemic in rural America, not that you have your crystal ball or anything. Where do you see the story going? What are you watching for?
CHRIS: I don’t think we’ve done a very good job yet of really assessing some of the market risks and losses for farmers at the moment. My readers are primarily farmers and people in agribusiness in some way or another. So really, going to need to assess and understand what’s happening to them financially. You’ve had different industries over the last three to five years have already had a lot of financial losses. Dairy has been through probably five years of struggles.
There was a lot of optimism coming into 2020 about cattle markets and hog markets and exports and things were going to turn around for these guys. And then they all got kind of hit with this situation. We’re going to see the risk of a lot more potential farmers going out of business. And then we’re going to see a lot of people admitting the fact that consolidation continues because farmers will get bigger, operations will get bigger. Filling in the gap for those that end up going out of business long term.
Health wise, it’s hard to fully understand exactly where we are going to be next because there’s so many mixed messages of how this virus is going to spread, how it’s going to come back in the fall, what our immunities are going to be like. There’re just so many uncertainties going forward. We’re all going to be watching what happens, I think just over the next couple of weeks as the states open up, so to speak, and then just see what happens to our healthcare system as a result. Where are we going to be in June 1st, that sort of thing.
TIM: So Chris, you mentioned something there that I had meant to get to. The places where farming is the dominant part of the economy and mining are two of the lowest infection rate types of counties that we have. But you raise a point about the economic roll over into say farming country about livestock production and just what’s happening with those producers right now who are unable to get their livestock to sell it for processing. That sounds catastrophic.
CHRIS: Yeah, it’s affecting the pork industry and poultry operations primarily at the moment. We built a system over a long period of time that really was just in time slaughter processing. Animals would hit a certain weight, they would be shipped off to the packing plant house, and as soon as that happens, then you would see another group of smaller animals coming in for you to feed out. Well, we’ve lost packing plant capacity and processing over the last few weeks. We’re talking about basically every day 150,000 hogs that should have gone to slaughter that did not. It really has backed up a lot of farms. And now you’re talking about the prospects, the situation of mass euthanasia to get rid of these animals, not just the market weight animals, but baby pigs, chickens, turkeys, it affects a lot of these industries.
And so, we were seeing milk dumping early on and people didn’t understand that. Now we’re going to likely see the risk of a lot of animals being killed just because we couldn’t take them to the processing plant to be killed. And that’s going to create a whole different group of not only issues raised with consumers in the public but the mental stress on farmers that have to deal with this.
TIM: Thank you. April, so what are you working on and what are the things you’re watching for the next phase of this story?
APRIL: Definitely looking at the funding and seeing how it targets or doesn’t rural places. Looking at the next bill to see how rural America benefits from it. I’m also, like I said, interested in just focusing on the people on the extreme margins and making sure that I reflect the nuances and how varied the experiences and rural places and how different the vulnerabilities are depending on location and industries that are available to you and the healthcare infrastructure.
Beyond that, I want to follow whether this accelerate some of the economic challenges that rural America has been facing or if there’s ways in which because some isolated, some economies are a bit more isolated, maybe they benefit or they’re just not hurt as severely.
TIM: Thank you. And how about you, Jourdan?
So much is next. For like a lot of the questions, we kind of overlap. Legislation is one of them and like the future of relief funds that will be going into Indian country as well as if the tribes will be getting this and how soon because there’s a lot of history there and red tape that people call it with the federal government. Also, students and going back to school is one thing. So a lot of these students had to go back home and now a lot of them are back in their rural communities, back at their ancestral homelands, or in cities too. And some of them don’t have access to Wi-Fi. So trying to complete their coursework or trying to graduate with this limited resource and the accessibility to it, whether it’s just going to McDonald’s or a coffee shop, which they can’t go to now or even having a car get there. Tribal colleges and universities also are trying to be a huge part of that. So trying to follow up with them.
JOURDAN: I think one thing is also his mental health because I think native people don’t have access to mental health services or there’s a lack of it out there for us. So, a lot of times, that’s how we get our mental health, I guess, our social being has to interact with that other person, especially elders. They’re often visited by people, and check in on them, make sure they’re doing okay, if they need anything. So I think the sense of isolation trying to social distance is going to really affect a lot of people [inaudible 00:38:12] experts say too. So how are the healthcare system going to address that and the Indian Health Service and the tribes who own their clinics.
And tribal casinos too are a huge part of I guess the economy in Indian country. Not a lot of tribes have a casino, but the ones that do, had to close them down. And actually this week, there’s supposed to be a couple opening up. So, we’re looking to see how that would be done. Are they going to space out machines, are they going to open certain parts of the casino? If they’re a Casino Resort, how is that going to operate? And some casinos that have resorts have opened up shelters for positive confirmed cases. For example, the Buffalo Thunder owned by the Pojoaque Buffalo in New Mexico, they opened up. From what I remember, 24 people are sheltering there because they live in overcrowded households that provides them a way to recover quickly without infecting other people.
I think a huge one that I’m working on right now is the virus surveillance for public health surveillance in Indian Country because that contributes to lack of data collection for native people around. Since because Indian Health System is so complex, there’s no one way for everybody to give their data to one place. And with that data, we’re able to calculate infection rates, we’re able to figure out predictive models, we’re able to figure out case fatality rates. And a lot of these times, this data is needed to figure out how to distribute resources or even how to distribute funds as well. And then part of that is also the census too is part of the whole data story that we’re looking at right now.
TIM: Thank you. So, I know at the Daily Yonder, we’re very interested in, as states begin to reopen, whether or not they meet the White House criteria for doing so. Are we going to see rebounds in the number of cases and deaths? And that’s something that we can track at the county level through usafacts.org, their data. And then the New York Times also, their database is also available for people who like digging through that stuff, which I do when I can get a little help and how to do it.
And the other thing that was an early and strong story about rural America is that there’s a lot of vulnerability in the population just as you’ve all discussed about, age, preexisting condition, economic status, ability to get to healthcare, etc. And so, these studies have all said, if rural America gets a rough infection rate, the impact could be harder in these rural areas than in some other parts of the United States.
So the question becomes, is it spreading and are we going to see, the rate of increase in the infection rate is much higher in rural areas, and that’s in part because it started at such a low number. If you have one case and you get two, your rate doubled. But is that trend going to continue or will kind of the lower population densities and some of the other factors that work in favor of rural communities and keeping infection rates a little lower, are those going to prevail? So, all of that will play out for who knows how long. Those are a couple of the things that we’re interested in keeping an eye on.
Well, I want to thank each of you for participating and sharing parts of your important work. I encourage everyone to take a look at what these journalists produce and the publications for which they produce them. They’re unique and they serve important niches within rural America. They’re outstanding in their own right, and then combine them and you get a very interesting look at a lot of different parts of rural America. So, April Simpson with Stateline the Pew Charitable Trusts, and Chris Clayton with DTN Progressive Farmer, Jourdan Bennett-Begaye, member of the Navajo Nation and Washington editor of the Indian Country Today. So thank you all for participating. And y’all stay well. I hope we can do this again sometime.